Normal ALT, AST ,can liver damage still happen?

[hepb1]

Hi,

Quick question, if ALT ,AST is normal long term in chronic hepb person, can liver damage still happen?

If liver is damaged ALT, AST level should be elevated.

Just talked to someone with chronic hepb but alt ast levels are normal but he seems to experience symptoms of hepb.

Br,

[ThomasTu]

Hi @hepb1,

Yes, there are quite a bit of evidence that in some HBV+ people, liver inflammation can be accompanied by a normal ALT level:

• Misconception: You Can’t Have Liver Disease With Normal Liver Chemistries - PMC
• Patients with chronic hepatitis B who have persistently normal alanine aminotransferase or aged < 30 years may exhibit significant histologic damage | BMC Gastroenterology | Full Text
• https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep4.1859

Hope this helps,
Thomas

[Opa]

Will there ever be a point in time when antiviral drugs will fail to help??.
If is what next is left???

[Ccheng8346]

If your HBsAntigen is >150 then even if your tumor markers are normal as well as your ALT you can still get HCC or cirrhosis. Perhaps genotype C is more virulent . Not sure of other genotype

[ThomasTu]

@Opa

Will there ever be a point in time when antiviral drugs will fail to help??.

Hi @Opa,

This is a question that the scientific/clinical community is grappling with and it is what governs a lot of the discussion over what treatment guidelines are agreed upon.

Thomas